International Physician Update

Getting Rid of Fibroids While Preserving the Uterus

Interventional Radiologist Kevin Kim performs 10 to 20 fibroid embolizations a month.

Erin Railey spends her days at a farm in Jacksonville, Md., feeding horses and cleaning their stalls. And though the work gets messy, 36-year-old Railey just loves being around horses. But three years ago, she thought her active outdoor life might be coming to an end.

Profuse uterine bleeding was forcing her to dash hourly to the bathroom for 20 consecutive days each month. At night, she would awaken with painful pressure on her bladder. Finally exhausted, Railey decided to see a doctor. A sonogram revealed a large fibroid, the size of a grapefruit, in her uterus.

Fibroids are benign tumors that affect 40 percent of all women over 40. As in Railey’s case, they can become troublesome as they continue to grow and even prevent pregnancy. Traditional treatment usually involves surgical removal of only the fibroids (myomectomy) or complete hysterectomy. But for Railey, a myomectomy would have left her with the chance the fibroids would return; a hysterectomy would quash her hopes of becoming pregnant.

Eventually Railey ended up at Hopkins where Kevin Kim, director of gynecologic intervention, offered her a simpler new therapy called uterine fibroid embolization. The procedure eliminates fibroids without destroying the uterus.

After Kim administers intravenous conscious sedation (similar to the kind used during wisdom teeth extraction), he makes a quarter-inch incision into the groin. A catheter is then threaded into the uterine artery that supplies blood to the fibroids, and calibrated microspheres (tiny, spongy beads) are injected into the artery, plugging the vessels that feed the fibroids. Deprived of blood and needed oxygen, the growths die and shrink. The uterus lives on.

“The uterus remains viable because we cut off the blood supply only to the enlarged recruited vessels to fibroids, sparing the remainder of the uterine blood vessels,” Kim explains. The procedure takes less than 45 minutes to perform and has been effective in over 90 percent of patients. He’s now performing 10 to 20 fibroid embolizations a month.

He operated on Railey in August 2001. She had to miss a week of work, but that was only because of the physical demands of her job, Railey says. Two years later, Railey reports she feels great: “Now I’m running to the bathroom for a good reason—I’m pregnant.”